Provider Demographics
NPI:1578734307
Name:KIM, LAUREN SOOJIN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:SOOJIN
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SOOJIN
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:415 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2140
Mailing Address - Country:US
Mailing Address - Phone:714-292-2980
Mailing Address - Fax:
Practice Address - Street 1:1400 N HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4110
Practice Address - Country:US
Practice Address - Phone:714-773-7000
Practice Address - Fax:714-870-5028
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12314171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist